Provider Demographics
NPI:1447404546
Name:LINCOLN PEDIATRICS
Entity Type:Organization
Organization Name:LINCOLN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SERGIWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-326-5400
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-0785
Mailing Address - Country:US
Mailing Address - Phone:219-326-5400
Mailing Address - Fax:219-326-5455
Practice Address - Street 1:414 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3350
Practice Address - Country:US
Practice Address - Phone:219-326-5400
Practice Address - Fax:219-326-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049378A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000305691OtherANTHEM BC/BS
IN200199090AMedicaid